Enlarge image
8888 CORRECTED
FILER’S name, street address, city or town, province or state, country, ZIP Filer is an (check one): OMB No. 1545-0029
or foreign postal code, and telephone no. Form 8922 Third-Party
Employer
(Rev. October 2024) Sick Pay
For calendar year Recap
Insurer/Agent
FILER’S employer identification number
For Privacy Act
and Paperwork
Reduction Act
OTHER PARTY’S name (see instructions before entering) 1 Sick pay subject to federal 2 Federal income tax withheld Notice, see
income tax from sick pay page 2.
$ $
3 Sick pay subject to social 4 Social security tax withheld
security tax from sick pay
$ $
OTHER PARTY’S employer identification number (see instructions before 5 Sick pay subject to 6 Medicare tax withheld from
entering) Medicare tax sick pay
$ $
Instructions for Form 8922 If your principal place of business is outside the United States, file
Section references are to the Internal Revenue Code unless otherwise with the Internal Revenue Service, IRS SSA CAWR, Philadelphia, PA
noted. 19255-0533.
Future Developments Private delivery services. Private delivery services can’t deliver to the
addresses shown above. If you choose to use a private delivery
For the latest information about developments related to Form 8922 service, send Form 8922 to the address shown below based on the
and its instructions, such as legislation enacted after they were location of your principal business, office, or agency.
published, go to www.irs.gov/Form8922.
Internal Revenue Service
What’s New 5333 Getwell Rd Stop 814 D6
Continuous-use form and instructions. Form 8922 and these Memphis, TN 38118
instructions have been converted from an annual revision to Internal Revenue Service
continuous use. Both the form and these instructions will be updated Mail Stop 4-G08 151
only as needed. 2970 Market St
Philadelphia, PA 19104
General Instructions Go to www.irs.gov/PDS for the current list of designated services.
Don’t send this form to the Social Security Administration.
This form is processed solely by the IRS for third-party sick Substitute Forms
▲! pay reporting. The IRS accepts quality substitute tax forms that are consistent with
CAUTION the official forms and have no adverse impact on our processing. The
official Form 8922 is the standard for substitute forms. Because a
Purpose of Form substitute form is a variation from the official form, you should know
Form 8922 is filed to reconcile employment tax returns (for example, the requirements of the official form for the year of use before you
Form 941) with Forms W-2 when third-party sick pay is paid. For more create a substitute version. For details on the requirements for
information, see Sick Pay Reporting in Pub. 15-A. substitute forms, see Pub. 1167.
Who Must File Specific Instructions
Generally, if the liability for the employer’s share of social security tax Calendar year. Enter the four-digit calendar year (for example, 2024)
and Medicare tax is reported on the employer’s employment tax for which you’re filing Form 8922.
return, Form 8922 must be filed by: Check box for employer or insurer/agent. Check the appropriate
• The employer, if sick pay is reported on Forms W-2 under the name box to state whether you’re the employer or the insurer/agent filing
and employer identification number (EIN) of the insurer or agent; or Form 8922.
• The insurer or agent, if sick pay is reported on Forms W-2 under the Filer’s name. If the Employer box is checked, the employer for whom
name and EIN of the employer. the sick pay was paid by the insurer or agent will complete the
For more information on who must file Form 8922, see Pub. 15-A. information with the employer’s name, address, and phone number.
When To File If the Insurer/Agent box is checked, the insurer or agent who paid
File Form 8922 by the last day of February. If the due date falls on a the sick pay will complete the information with the insurer/agent’s
Saturday, Sunday, or legal holiday, the due date is the next business name, address, and phone number.
day. Filer’s EIN. If the Employer box is checked, enter the EIN of the
employer.
Where To File If the Insurer/Agent box is checked, enter the EIN of the insurer or
Send Form 8922 to the following address. agent.
If your principal business, office, Use the following Other party’s name and EIN. If the Employer box is checked, the
or agency is located in address employer must provide the name and EIN of the insurer or agent. If the
Alabama, Alaska, Arizona, Arkansas, Colorado, Florida, Internal Revenue Service employer has contracts with more than one insurer or agent, the
Georgia, Hawaii, Kansas, Louisiana, Mississippi, Missouri, Memphis Service Center employer must file a separate Form 8922 for the wages and taxes
Nevada, New Mexico, Oklahoma, Tennessee, Texas, P.O. Box 87 Mail Stop 814 D6 related to each contract.
Utah, Washington Memphis, TN 38101-0087 If the Insurer/Agent box is checked, the insurer or agent may, but
California, Connecticut, Delaware, District of Columbia, isn’t required to, provide the name and EIN of the employer. If it is
Idaho, Illinois, Indiana, Iowa, Kentucky, Maine, Maryland, providing this information, and if it has contracts with more than one
Massachusetts, Michigan, Minnesota, Montana, Internal Revenue Service employer, it must file a separate Form 8922 for the wages and taxes
Nebraska, New Hampshire, New Jersey, New York, North IRS SSA CAWR
Carolina, North Dakota, Ohio, Oregon, Pennsylvania, Philadelphia, PA 19255-0533 related to each employer. Alternatively, it may file a separate Form
Rhode Island, South Carolina, South Dakota, Vermont, 8922 for the wages and taxes related to each employer for which it is
Virginia, West Virginia, Wisconsin, Wyoming
Form 8922 (Rev. 10-2024) Cat. No. 37734T www.irs.gov/Form8922 Department of the Treasury - Internal Revenue Service
